The Gold Standard: A Sense of Belonging

By Michelle GoldNetwork, Spring-Summer 2007

How much do you feel a part of your community? In Ontario, two-thirds of residents report a strong or somewhat strong sense of community belonging. That’s a statistic for health, as people reporting a strong sense of community belonging were two times as likely to report excellent or very good mental health in the same survey.

The concept of ‘social capital’ can help explain why community belonging affects population health. Social capital refers to the social networks that exist within a community. These include bonding among individuals through social ties and relationships, as well as bridging between groups.

Social ties, which can include intimate relationships, family, friends, colleagues and acquaintances, can enhance mental health and sense of well-being, as they promote feelings of attachment and companionship, enhancing one’s sense of purpose and self-esteem. It is well recognized and demonstrated through research that people who feel socially isolated are at increased risk of depression. Social ties can also serve as protective factors for mental health. For those experiencing stress, one’s social network can provide personal support and enhance coping. Social contacts are also a source for sharing information. It has been suggested that knowledge of resources promotes a sense of personal control that enhances one’s ability and confidence to deal with adversity, thereby moderating distress.

Community participation and civic engagement have also been associated with better self-reported mental health. Participating in social clubs and recreational activities or volunteering can enhance social ties, which create the circumstance that enable people to receive the positive health outcomes just described. Empowerment can be a significant benefit from civic engagement. Signing a petition, joining a neighbourhood improvement group or even voting, all heighten the opportunity to influence decision-makers, which ultimately can impact one’s ability to acquire desired resources. This empowers people to gain control over social, economic and political forces to improve their lives.

A socially inclusive society is one where all people feel valued, their differences are respected and they are able to participate to meet their needs. Conversely, social exclusion is the situation where people are shut out from the social, economic and political systems that contribute to the social integration of individuals in society.

There are some thoughtful activities taking place to promote mental health and lessen social exclusion of persons with serious mental illness among policymakers who understand the value of applying the concept of social capital to mental health. In Australia, the state of Victoria has funded the Victorian Health Promotion Foundation as an independent authority reporting to the Minister of Health under the name VicHealth. One of its strategic priorities is promoting mental health by funding projects that enhance social inclusion.

Guided by the country’s mental health strategy, this Australian state has undertaken a comprehensive evidence-based review of effective strategies to promote mental health. VicHealth identifies nine strategies that have been shown to be effective in increasing social ties and fostering social inclusion: community building and neighbourhood renewal programs; school-based programs for mental health; workplace mental health promotion; programs that provide social support, such as parent training programs; volunteering; community arts programs; physical activity; media campaigns that challenge stigma and raise mental health literacy; and civic structures that encourage community participation in decision-making.

They are already at the midpoint in implementing their mental health promotion plan. Some of their funded programs include promoting mental health through the creative arts, increasing access to recreation and physical activity, and supporting children who have a parent with a mental illness. Their evidence-based plan should be required reading for everyone concerned with the promotion of mental health.

Closer to home, initiatives that focus on enhancing social inclusion to promote health with an implicit benefit for mental health include Inclusive Cities Canada and Count Me In!: Tools for an Inclusive Ontario.

Other countries are focusing their effort on reducing social exclusion. Mind, a mental health charity in England and Wales more formally called the National Association for Mental Health, explains:

‘Social exclusion is what happens when society marginalizes people so that they are not able play a full and equal part in their community. Many people who experience mental distress live in poverty and experience stigma and discrimination. They may find it hard to access employment or find adequate housing. The net result is that people can become seriously isolated and excluded from social and working life.’

The Social Exclusion Unit in the United Kingdom has identified persons with serious mental illness as one of the most excluded groups in society. They offer five reasons why persons with serious mental illness remain on the margins: stigma and discrimination; professionals across service sectors have` low expectations; lack of social and informational support to encourage participation; barriers to accessing community resources; and lack of clear responsibility as to who is responsible for promoting better outcomes. They are setting specific goals and objectives to ensure that policies, services and supports are aligned and coordinated to reduce social exclusion. Enhancing vocational services for persons with serious mental issues is one of their priorities to reduce the cycle of poverty and consequences of economic exclusion.

The World Health Organization has written extensively on promoting mental health. They reaffirm that the Ottawa Charter for Health Promotion (1986) strategies of developing personal skills, strengthening community action, creating supportive environments and building healthy public policy continue to be the foundation for promoting mental health. To be effective, these strategies must be taken up and acted upon not only by the mental health sector but also by the broader community. Reorienting health services is the fifth strategy identified in the Ottawa Charter, but it exists alongside health promotion, rather than being central to it.

Here at CMHA Ontario, we have been involved with our branches across the province in revisiting our thinking about mental health promotion. Our action framework includes meaningful relationships, inclusion and participation as key outcomes that promote mental health. Our approach references the two-continuum model for mental health, applicable to people both with and without serious mental illness. Applying this model, we concur that mental health can be promoted by both fostering social inclusion and remedying social exclusion.

The Ministry of Health Promotion indicates that mental health and addictions is one of its four strategic priorities. However, few directions are yet evident. Practical, evidence-based strategies for enhancing social inclusion and reducing social exclusion, such as those taking place in other jurisdictions, should be a key consideration for discussion with provincial stakeholders as the ministry moves forward in setting policy directions to promote mental health in Ontario.